An obscure IRS rule takes effect on Wednesday under which small businesses that get caught helping their workers buy insurance or pay medical bills can be fined 18 times more than larger employers that don’t provide coverage at all, warned the National Federation of Independent Business (NFIB) today.

The next bit of scrutiny on SCOTUScare — to borrow a new name for the federal health reform act coined by U.S. Supreme Court Justice Antonin Scalia — in health care is all about the workplace now that health insurance tax credits are securely in place.

The jeopardy of tax credits overshadowed that employers have big changes ahead under the employer mandate of the Affordable Care Act. The Supreme Court affirmed in King vs. Burwell Thursday the federal government’s position that tax credits, which help many people afford monthly insurance premiums, are available on both federally and state-run exchanges.

Last year, 95 American hospitals merged or were acquired — a 40 percent increase from 2010. Over roughly the same period, the percentage of physician practices owned by hospitals doubled — from about 30 percent to nearly 60 percent.

This rapid consolidation among U.S. healthcare providers is dizzying to behold, even for those who have spent careers in healthcare. Its effects are only starting to be felt, but could be profound.

King v. Burwell is in the history books. Subsidies on federal exchanges will continue to flow and supporters of the ACA will (correctly) see this as a big win for the president. But to pretend that this means smooth sailing for Obamacare from here on out would be disingenuous at best.

Obamacare subsidies are just one important leg of a three-legged stool. And two of them may start wobbling after 2016.

The Affordable Care Act narrowly escaped a judicial decision that would have shrunk its reach Thursday when the Supreme Court ruled the IRS could continue distributing insurance subsidies nationwide. Now, with the law no longer under an immediate meaningful threat of repeal, some are looking to stretch Obamacare further.

Specifically, governors in several states are renewing their push to expand Medicaid, hoping to bring the federal low-income health insurance program to more of their state’s residents.

Despite the Supreme Court decision to uphold the subsidies for private insurance in King v. Burwell, the fundamental problems with the Affordable Care Act remain. Ironically, it is the growing government centralization of health insurance at the expense of private insurance that must be addressed.

Despite having survived a challenge in the U.S. Supreme Court, the federal government’s health insurance markets face weighty struggles as they try to keep prices under control, entice more consumers and encourage quality medical care.

The government’s insurance markets – as well as more than a dozen run by states — have been operating for less than two years and are about to lose their training wheels. Start-up funds that have helped stabilize prices and partially pay for administration of the marketplaces are ending, feeding fears that premiums may rise after next year at a steeper rate.

By one standard no government program can fail, and that’s the standard being applied to ObamaCare by its supporters: If a program exists and delivers benefits, the program is working.

Paul Krugman, Nancy Pelosi and others consistently point to the fact that people are willingly receiving ObamaCare benefits as proof of the program’s value. Mr. Obama himself says: “When you talk to people who actually are enrolled in a new marketplace plan, the vast majority of them like their coverage. The vast majority are satisfied.”

The House voted Tuesday to abolish a cost-cutting board under ObamaCare that has drawn criticism from members of both parties.

Lawmakers voted 244-154 to abolish what is known as the Independent Payment Advisory Board (IPAB). The board is tasked with coming up with Medicare cuts if spending rises above a certain threshold, but has been criticized as outsourcing the work of Congress to unelected bureaucrats.

Repeal of the board has split Democrats, 20 of whom cosponsored the repeal bill. Eleven voted with Republicans on Tuesday to kill it.